Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0129X | Vascular Surgeon | 11385 | AL |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 11385 | AL |
NPI | 1063560563 |
---|---|
Provider Name | Dr. Michael E Damrich |
First Address | Mobile, AL 36607-2303 |
Second Address | Mobile, AL 36607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 22/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000019745 | (05) | AL |
0012794 | MS MCAID PROVIDER # (01) | MS |
3710021 | UHC PROVIDER # (01) | AL |
4006504 | AETNA PROVIDER # (01) | AL |
C70659 | (02) | AL |